The National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Rule (CCR) have established criteria developed by physicians establishing when a patient needs cervical neck imaging radiographs to safely avoid over use in appropriate patients:

Is there any high-risk factor that mandates radiography? *

Is there any low-risk factor that allows safe assessment of range of motion?

Can the patient actively rotate his or her neck 45° right and left?

My patient (above) was involved in a traumatic bicycle sports accident*. Even though he could rotate 45 degrees it was guarded rotation and with “dangerous mechanism”.

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